Selective ADH-induced hypertrophy of the medullary thick ascending limb in Brattleboro rats

A morphometric study was undertaken to quantitate the morphologic changes induced by ADH availability in the rat kidney. Homozygous Brattleboro rats with hereditary diabetes insipidus (DI) (no ADH) were compared to heterozygous Brattleboro control rats (HZ) and to DI rats after 5 to 6 weeks of continuous ADH infusion by implantable Alzet osmotic minipumps (TDI). ADH resulted in a 37% increase in mass of kidney per unit body wt. All kidney zones and all nephron segments were not increased uniformly. The inner stripe was enlarged more than other renal zones. It represented 15.5 +/- 0.7% of the total kidney height along the cortico-papillary axis in DI and 22.2 +/- 1.5% in TDI (P less than 0.025). The volume of the inner stripe in DI and TDI amounted to 10.9 +/- 0.9 and 18.0 +/- 1.0% of the total kidney volume, respectively (P less than 0.001). Selective increases in tubular diameter and cell height, due mostly to an hypertrophy of pre-existing cells, were observed in the earliest part of the thick ascending limbs (TAL) in the inner stripe, resulting in a twofold increase in epithelial volume per unit tubular length (P less than 0.001). Volume density of mitochondria and surface density of basolateral membranes were unchanged but, due to the increase in cell volume and inner stripe thickness, the amount of mitochondria and the surface area of basolateral membrane in the TAL were more than tripled in the inner stripe of treated rats. These changes provide a much greater salt transport capacity in the TAL of treated rats. They probably represent an adaptation of the early TAL to an enhanced sodium chloride transport in response to a direct ADH stimulation and/or to an increased salt delivery to this segment in the concentrating kidney.     

Renal medullary Na-K-ATPase and hypoxic injury in perfused rat kidneys

We wished to see if chronic alterations in Na-K-ATPase activity in the medullary thick ascending limb would modify the susceptibility of its cells to the hypoxic injury produced by perfusion of the isolated kidney. Rats were fed a diet high (64%) or low (8%) in protein for three weeks. Renal medullary Na-K-ATPase was 75 +/- 12 U/mg protein/hr (mean +/- SE) in the high protein group and 44 +/- 3 in rats given low protein. After 90 minutes of perfusion, the kidneys of rats fed a high protein diet showed almost all mTAL cells near the inner medulla with severe damage (93 +/- 4.8%), whereas the same zone in perfused kidneys of rats on a low protein diet showed only 47 +/- 7.7% injury. In a similar fashion, damage to mTAL cells seen in perfused kidneys was greatly augmented by compensatory renal hypertrophy produced by removal of the contralateral kidney two weeks earlier, and by a diet high in potassium given for two weeks, procedures which also increased the activity of medullary Na-K-ATPase. The results suggest that the level of transport work of medullary cells mediated by Na-K-ATPase is a determinant of the vulnerability of mTAL cells to hypoxic injury.     

Cyclosporine nephropathy: morphometric analysis of the medullary thick ascending limb.

The effects of cyclosporine A (CsA) (12.5 mg/kg/d) on the medullary thick ascending limb (mTAL) were studied in five experimental groups: vehicle-treated control (C), salt depletion (SD), cyclosporine (CsA), and the combination of both salt depletion and cyclosporine for 3 (CsA-SD:S) and 8 (CsA-SD:L) weeks. Evaluation was performed on 1-micron plastic horizontal sections. mTALs were classified as either atrophic or nonatrophic by assessing mitochondrial density. The mean cross-sectional area of atrophic mTALs was found to be significantly smaller than the mean of nonatrophic mTALs in all treatment groups. The percentage of atrophic tubules was found to be significantly increased in both CsA-SD groups as compared with the other three treatment groups (P less than 0.01). Regression analysis indicated a rectangular hyperbolic relationship between the percentage of atrophic tubules and mean nonatrophic tubule cross-sectional area (P less than 0.0001). Thus, low levels of injury are associated with a rapid increase in cross-sectional tubular area (hypertrophy), and this response plateaued with increasing degrees of injury. Terminal plasma creatinine correlated with nonatrophic tubular cross-section area (r = 0.52, P less than 0.003). These studies indicate that CsA induces mTAL atrophy, which is more extensive with salt depletion. With limited injury, hypertrophy develops. However, the hypertrophic response cannot be sustained with increasing degrees of injury. The phenomenon of mTAL atrophy and hypertrophy is particularly important, since hypertrophy itself is a known risk factor for mTAL injury.     

Mycophenolic acid reduces renin-angiotensin-system activity in cultured mouse medullary thick ascending limb cells

Mycophenolate mofetil (MMF) is a promising immunosuppressive agent. The intra-renal renin-angiotensin system (RAS) plays an important role in the regulation of intra-renal hemodynamics. Mycophenolic acid (MPA) is the bioactive metabolite of MMF. The interaction between MPA and intra-renal RAS is still unclear. We hypothesized that MPA might affect intra-renal RAS activity. We chose models of cultured mouse medullary thick ascending limb (mTAL) cells for the experiments, as the mTAL is one of the major sites of intra-renal RAS. We investigated the angiotensin-converting enzyme (ACE) activity by means of enzymatic assay, and the angiotensin-receptor activity by means of a binding study with radiolabeled angiotensin II, and measured the intracellular calcium concentration in cultured cells treated with and without MPA. ACE activity changed neither in cells incubated with MPA nor in those treated without MPA. The binding study also indicated decreased angiotensin-II binding in MPA-treated (MPA 10(-7) M) cells, up to 43.7%. The decreased intracellular calcium concentration in MPA-treated cells further confirmed the MPA-inhibitory effect on the angiotensin receptor. We conclude that MPA reduces intra-renal RAS activity mainly through the decrease of AT1 receptor activity without affecting ACE activity. The results suggest that the inhibitory effect of MPA in the intra-renal RAS might play a role in the extra-immunosuppressive effect of MMF.     

Apoptosis of the thick ascending limb results in acute kidney injury

Ischemia- or toxin-induced acute kidney injury is generally thought to affect the cells of the proximal tubule, but it has been difficult to define the involvement of other tubular segments because of the widespread damage caused by ischemia/reperfusion or toxin-induced injury in experimental models. For evaluation of whether thick ascending limb (TAL)-specific epithelial injury results in acute kidney injury, a novel transgenic mouse model that expresses the herpes simplex virus 1 thymidine kinase gene under the direction of the TAL-specific Tamm-Horsfall protein promoter was generated. After administration of gancyclovir, these mice demonstrated apoptosis only in TAL cells, with little evidence of neutrophil infiltration. Compared with control mice, blood urea nitrogen and creatinine levels were at least five-fold higher in the transgenic mice, which also developed oliguria and impaired urinary concentrating ability. These findings suggest that acute injury targeted only to the TAL is sufficient to cause severe acute kidney injury in mice with features similar to those observed in humans.     

Cyclosporine decreases prostaglandin E2 production in mouse medullary thick ascending limb cultured cells

Intrarenal vasoconstriction is thought to be the major pathogenesis of cyclosporine (CsA) nephrotoxicity. Nitric oxide (NO) and prostaglandin E2 (PGE2) are two of the major intrarenal vasodilators, which protect kidney from ischemia. CsA inhibited NO production in renal epithelial cells. The interaction between CsA and intrarenal PGE2 and NO production is still unclear. The aim of the study is to evaluate the interaction of CsA with intrarenal PGE2 and NO production in renal epithelial cells. Models of cultured mouse thick ascending limb (TAL) cells are chosen to perform the experiments, as TAL cells are the major site of intrarenal PGE2 production and target of CsA nephrotoxicity. We investigated the PGE2 production by enzyme-linked immunosorbent assay, and cyclooxygenase (COX-1 and COX-2) mRNA expression by RT-PCR in cultured cells treated with or without CsA. TAL cells maintained the main characteristics of their parental cells. TAL cells produce PGE2 mainly by COX-1 in steady state and by COX-2 in stimulated state by lipopolysaccharide (LPS). CsA (100 ng/ml) significantly reduced the PGE2 production up to 43% in TAL cells in LPS stimulated status (control versus CsA: 375.1 +/- 15.5 vs. 187.2 +/- 12.2 nm/mg protein, n = 7, P < 0.001). The effects were dose-dependent. The mRNA expression of COX1 is not affected and COX-2 is decreased in CsA-treated TAL cells. NO donor could prevent the inhibitory effects of CsA. We concluded that CsA decreased intrarenal PGE2 production in stimulated status mainly by decreasing COX-2 expression. NO might play a role in the CsA effect. The results suggested the role possible of PGE2 in CsA nephrotoxicity.     

Renal outer medullary potassium channel knockout models reveal thick ascending limb function and dysfunction

The renal outer medullary potassium channel (ROMK) is an adenosine triphosphate-sensitive inward-rectifier potassium channel (Kir1.1 or KCNJ1) highly expressed in the cortical and medullary thick ascending limbs (TAL), connecting segment (CNT) and cortical collecting duct (CCD) in the mammalian kidney, where it serves to recycle potassium (K⁺) across the apical membrane in TAL and to secrete K⁺ in the CNT and CCD. ROMK channel mutations cause type II Bartter’s syndrome with salt wasting and dehydration, and ROMK knockout mice display a similar phenotype of Bartter’s syndrome in humans. Studies from ROMK null mice indicate that ROMK is required to form both the small-conductance (30pS, SK) K channels and the 70pS (IK) K channels in the TAL. The availability of ROMK^−/− mice has made it possible to study electrolyte transport along the nephron in order to understand the TAL function under physiological conditions and the compensatory mechanisms of salt and water transport under the conditions of TAL dysfunction. This review summarizes previous progress in the study of K⁺ channel activity in the TAL and CCD, ion transporter expression and activities along the nephron, and renal functions under physiological and pathophysiological conditions using ROMK^−/− mice.     

Platelet activating factor inhibits Cl and K transport in the medullary thick ascending limb.

Since the kidney medulla was reported to generate platelet activating factor (PAF), we investigated a possible effect of this agent on the reabsorptive function of in vitro microperfused medullary thick ascending limbs from mouse kidney (mTAL). PAF, 10(-7) M in the bath, significantly decreased the net chloride flux (JCl) from 48.8 +/- 7.1 to 27.4 +/- 5.7 pmol/min. This effect was reversible, blocked by the antagonist BN 50730, and not reproduced by the inactive metabolite lyso-PAF. PAF inhibited the transepithelial potential difference with a threshold at 10(-9) M. In the presence of isoproterenol, the PAF-induced decrease of JCl was not significantly different from that observed in basal conditions; moreover, PAF did not modify the adenylate cyclase activity in isolated mTALs, either in basal condition or under stimulation by isoproterenol. The effect of PAF on JCl was not prevented by mepacrine, NDGA associated with proadifen, or adenosine desaminase. When the apical Na-K-2Cl cotransport was blocked by furosemide or bumetanide, a net K secretion occurred (-1.1 +/- 0.2 pmol/min), which was significantly decreased by PAF (-0.06 +/- 0.3 pmol/min). Moreover, it was verified on isolated mTALs that PAF did not modify the Na,K-ATPase activity. It is concluded that PAF inhibits the reabsorptive function of the mTAL, as indicated by the decrease of Cl reabsorption and K secretion. This effect could not be accounted for by adenosine or arachidonic acid metabolite action, and was not mediated by an inhibition of the adenylate cyclase activity.     

Effects of graded oxygen tension on adenosine release by renal medullary and thick ascending limb suspensions.

Adenosine is released from renal cells, and extracellular adenosine may influence the effects of ischemia on medullary tubule segments by altering ion transport or renal hemodynamics. While adenosine release and excretion are enhanced during renal ischemia, the specific sites of renal adenosine production have not been completely elucidated. In the present study, extracellular adenosine concentrations in suspensions of renal outer medulla and thick ascending limb segments were quantitated by reversed-phase high performance liquid chromatography. Media from other medullary (OM) suspensions incubated for 8 and 15 minutes at 0% oxygen contained significantly greater amounts of adenosine (1.404 +/- 0.21 and 2.034 +/- 0.27 ng/micrograms protein, respectively), when compared to values obtained from media of suspensions incubated for equivalent periods under non-hypoxic conditions (8, 20, and 95% oxygen), 0.78 +/- 0.05 (8 min) and 1.37 +/- 0.21 ng/micrograms protein (15 min). Similarly, adenosine release was greater in medullary thick ascending limb (mTAL) suspensions incubated for 8 minutes at 0% versus 8% oxygen (0.81 +/- 0.17 vs. 0.20 +/- 0.12 ng/micrograms protein, respectively). Moreover, the observed increase in adenosine release by thick ascending limbs at 0% oxygen could be inhibited completely by either furosemide or ouabain. These studies demonstrate that: 1) the renal medulla and medullary thick ascending limb are sites of adenosine release; 2) adenosine release by the mTAL is enhanced significantly during hypoxic conditions; and 3) the increased release of adenosine during hypoxia appears to be related to ion transport and oxidative metabolism, as the increased release was prevented by two disparate inhibitors of transport in this segment.     

Proximal tubular injury attenuates outer medullary hypoxic damage: studies in perfused rat kidneys

The straight segment (S3) of the proximal tubule is predominantly damaged during renal ischemia-reflow, whereas medullary thick ascending limbs (mTALs) are principally affected in other models of hypoxic acute tubular necrosis (ATN). Since the latter injury pattern largely depends on the extent of reabsorptive activity during hypoxic stress, we hypothesized that proximal tubular damage might attenuate downstream mTAL injury by means of diminished distal solute delivery for reabsorption. In isolated rat kidneys perfused for 90 min with oxygenated Krebs-Henseleit solution, mTAL necrosis developed in 75 +/- 3% of tubules in the mid-inner stripe of the outer medulla. By contrast, S3 segments in the outer stripe were minimally affected, with tubular fragmentation involving some 5 +/- 2% of tubules. In kidneys subjected in vivo to proximal tubular injury and subsequently used for isolated perfusion studies, the injury pattern was inverted: following 20 and 30 min ischemia and reflow for 24 h, S3 fragmentation rose to 18 +/- 16% and 72 +/- 13%, while mTAL damage was reduced to 33 +/- 10 and 24 +/- 8%, respectively. In kidneys subjected in vivo to D-serine S3 necrosis rose to 100%, while mTAL damage fell to 1 +/- 1% (p < 0.001). Substantial S3 tubular collapse (involving approximately 30% of tubules) and inner stripe interstitial hemorrhage were also noted, exclusively in kidneys subjected to ischemia-reflow. Proximal tubular necrosis alone or in combination with collapse inversely correlated with mTAL necrosis (R = -0.51 and -0.72, respectively, p < 0.003). This cogent inverse association might imply that disruption of the proximal nephron attenuates downstream mTAL necrosis by a reduction of distal tubular reabsorptive workload.     

Cyclosporine reduces basolateral,but not apical,nitric oxide secretion in medullary thick ascending limb cells

Abstract Cyclosporine (CsA) reduces nitric oxide (NO) production in medullary thick ascending limb (mTAL) cells. We postulated that CsA affected NO secretion in a vectorial manner in polarized renal epithelial cells. The experiments were performed in a model of mTAL sub‐cultured cells. The expression of iNOS in mTAL cells was confirmed by RT‐PCR. The cells were grown on a non‐permeable filter. Nitrite was measured by the modified Griess method. Transepithelial resistance was measured to ensure the integrity of the tight junction. CsA (100 ng/ml) reduced NO production by 22% in mTAL cells. The inhibitory effect was limited to the basolateral side (control: 165 ± 11; plus CsA: 93 ± 17 nM/10⁶ cells, P < 0.001) without affecting apical NO secretion. The transepithelial resistance through the epithelial monolayer remained unchanged in CsA‐treated cells. CsA reduced basolateral NO secretion without affecting apical secretion. The results suggest that CsA might affect intra‐renal hemodynamics at the peritubular level.     

Adrenal corticosteroid action on the thick ascending limb.

Several lines of evidence support the view that corticosteroids stimulate Na+, K+, HCO3-, and H+ transport by the TAL and that modulation of transport contributes to homeostasis of these ions. Although some details of the cellular and molecular mechanisms of corticosteroid action in the amphibian diluting segment are known, little is known about these pathways in TAL cells. In addition, the issue of mineralocorticoid versus glucocorticoid specificity and receptor localization in the TAL is not resolved. We anticipate that these intriguing issues will be addressed using TAL cells in culture and isolated TAL in conjunction with patch clamp, fluorescent probes and molecular biological approaches.